Prospective observational study evaluating the outcome of a fixed angle plate (proximal humerus internal locking system) in proximal humerus fractures

Authors

  • Kiran Ramachandran Department of Orthopaedics, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
  • Jackson Mathew Department of Orthopaedics, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
  • Praveen Koraboina Department of Orthopaedics, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
  • Ponnezhathu Sebastian John Department of Orthopaedics, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20195804

Keywords:

PHILOS plate, Proximal humerus fracture, Post-operative complications

Abstract

Background: Proximal humerus fractures are common among elderly. The present study assesses the functional outcomes of fixed angle plate (proximal humerus internal locking system (PHILOS)) in fractures of proximal humerus.

Methods: 30 participants aged ≥18 years with proximal humerus fracture (2, 3 and 4 part) who underwent PHILOS fixation were enrolled. Undisplaced, open, severely comminuted, metastatic, and pathological fractures and with associated head injury and neurovascular injuries wew excluded. Clinical and radiological evaluation were done pre and post-operatively. Intraarticular extent of fracture geometry was assessed using 3-dimensional computed tomography. Participants were managed preoperatively with analgesics and shoulder immobilizer followed by preanesthetic check-up and routine investigations and surgery was done once participants were stable. Sample size was calculated assuming excellent or satisfactory results in 80% participants 6 months after surgery, relative precision of 20%, α of 5% and 10% attrition rate. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.

Results: Mean age of study participants was 62.9 (14.9) years and were predominantly females (66.6%, n=20). No significant difference between type of fracture and duration of recovery was observed (p=0.4). 30% participants had post-operative complications, stiffness was the most common (13.3%, n=4) complication. 76.6% (n=23) participants had good functional outcomes. Significant correlation between type of fracture and NEER score was observed (p<0.0001).

Conclusions: PHILOS is a preferential implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures in younger patients, and osteoporotic fractures in elderly, thus allowing early mobilization and satisfactory final functional outcome. 

References

Doshi C, Sharma GM, Naik LG, Badgire KS, Qureshi F. Treatment of Proximal Humerus Fractures using PHILOS Plate. J Clin Diagn Res. 2017;11(7):RC10–3.

Fallatah S, Dervin GF, Brunet JA, Conway AF, Hrushowy H. Functional outcome after proximal humeral fractures treated with hemiarthroplasty. Can J Surg. 2008;51(5):361–5.

Chu SP, Kelsey JL, Keegan THM, Sternfeld B, Prill M, Quesenberry CP, et al. Risk factors for proximal humerus fracture. Am J Epidemiol. 2004;160(4):360–7.

Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79(2):203–7.

Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury. 1998;29(5):349–52.

Calvo E, de Miguel I, de la Cruz JJ, López-Martín N. Percutaneous fixation of displaced proximal humeral fractures: indications based on the correlation between clinical and radiographic results. J Shoulder Elbow Surg. 2007;16(6):774–81.

Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115–20.

Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79(2):295–300.

Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am. 2003;85(9):1647–55.

Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82(8):1107–12.

Meier RA, Messmer P, Regazzoni P, Rothfischer W, Gross T. Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma. 2006;20(4):253–60.

Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand. 1986;57(4):320–3.

Wanner GA, Wanner-Schmid E, Romero J, Hersche O, von Smekal A, Trentz O, et al. Internal fixation of displaced proximal humeral fractures with two one-third tubular plates. J Trauma. 2003;54(3):536–44.

Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;(430):176–81.

Lill H, Hepp P, Rose T, König K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach - technique and first results]. Zentralbl Chir. 2004;129(1):43–8.

Gupta AK, Gupta M, Sengar G, Nath R. Functional outcome of closed fractures of proximal humerus managed by Joshi’s external stabilizing system. Indian J Orthop. 2012;46(2):216–20.

Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: Sharp increase in 1970-1998 and alarming projections for the new millennium. Acta orthopaedica Scandinavica. 2000 Nov 1;71:465–70.

Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int. 1994;4(5):277–82.

B Young T, Wallace WA. Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Br. 1985 Jun 1;67:373–7.

Wijgman AJ, Roolker W, Patt TW, Raaymakers ELFB, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84(11):1919–25.

Siwach R, Singh R, Rohilla RK, Kadian VS, Sangwan SS, Dhanda M. Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis. J Orthop Traumatol. 2008;9(3):149–53.

Neer CS. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52(6):1090–103.

Pendyala G, Joshi S, Choudhary S. The Ageing Nation. Indian J Community Med. 2014;39(1):3–7.

Sharafeldin KN, Quinlan JF, Corrigan JM, Kelly IP. Functional follow-up of locking plate fixation of fractures of the proximal humerus. European Journal of Orthopaedic Surgery & Traumatology. 2007;18:87–92.

Scharoun SM, Bryden PJ. Hand preference, performance abilities, and hand selection in children. Front Psychol. 2014;5:82.

Parmaksizoğlu AS, Sökücü S, Ozkaya U, Kabukçuoğlu Y, Gül M. Locking plate fixation of three- and four-part proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44(2):97–104.

Launonen AP, Sumrein BO, Lepola V. Treatment of proximal humerus fractures in the elderly. Duodecim. 2017;133(4):353–8.

Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong). 2009;17(1):15–8.

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23(3):163–72.

Gerber C, Werner CML, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86(6):848–55.

Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M. The PHILOS plate for proximal humeral fractures--risk factors for complications at one year. J Trauma Acute Care Surg. 2012;72(3):783–92.

Geiger EV, Maier M, Kelm A, Wutzler S, Seebach C, Marzi I. Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44(1):1–6.

Roberson TA, Granade CM, Hunt Q, Griscom JT, Adams KJ, Momaya AM, et al. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg. 2017;26(6):1017–22.

Downloads

Published

2019-12-24

Issue

Section

Original Research Articles